Intracranial hemorrhage associated with vitamin K deficiency in a breastfed infant after intramuscular vitamin K prophylaxis at birth. follow-up at 18 months.

Hemorrhagic disease of the newborn or, more precisely, vitamin K deficiency bleeding (VKDB) in infancy, according to the Committee of the International Society on Thrombosis and Hemostasis (1), is a bleeding disorder due to vitamin K deficiency. It generally occurs during the neonatal period, but it is occasionally seen in infants several months old (2–4). The postnatal administration of vitamin K has dramatically reduced the incidence of VKDB during the first weeks of life, although sporadic cases with late-onset hemorrhage are described among exclusively breastfed infants who did not receive additional prophylaxis (5–7). In Italy, vitamin K prophylaxis at birth is routinely administered by a single injection of 1 mg of intramuscular vitamin K, or a 2-mg dose of oral vitamin K, but additional supplementation to exclusively breastfed infants is not consistent. We observed an exclusively breastfed infant who was treated appropriately with vitamin K at delivery but received no additional exogenous vitamin K thereafter, and subsequently developed a severe intraparenchymal and intraventricular hemorrhage.